I don't understand...

(I will get back to the "most controversial" topic in a bit - it's going to take me awhile to write).

I have recently been told stories by a good friend, my sister and my mother. They all involved slightly varying stories of tearing so badly in childbirth they required an hour +/- of stitching after.

This makes me really angry. At the OB's/doctors. There are ways to prevent much of the serious tearing that happens in childbirth. It takes a little effort and care by the birth attendant.

Don't OB's care??? Why don't they do anything to prevent this awful tearing (and no - prevention does not = episiotomy either!) Is it money? They can charge more for the careful stitching they do afterwards?

My heart breaks for these poor mama's. And it's just SO common (no surprise since 99% of births take place in hospitals and apparently very few doctor's care to do anything to prevent the tearing).

It's NOT a part of normal birth. Minor tearing, sure. It happens. Major tearing requiring an hour of repair? No. Not normal. At least it shouldn't be.

Tearing has nothing to do with (or very little to do with) the size of the baby. I have heard of mama's tearing from birthing their small 5lb. babies and I have heard of women birthing 12 lb. babies with NO tearing. (No joke!).

Midwives have (comparatively) VERY low rates of tearing. Many mama's don't tear at all, others require only a stitch or two. While I'm not a midwife and don't know all of the tricks of the trade, I will list some things I do know that help prevent tearing, in case any mama's want to try to help themselves if their doctor's refuse (or don't know how) to help them.

1 - If possible, labor in water for some time. This softens all of the tissues. This is probably mostly helpful during the end of labor. (Besides the fact that it provides much pain relief from contractions as well!)

2 - If at all possible, do not push lying flat on your back. This is the worst position for labor and delivery. (Yet the status quo in hospitals. Why? Easier access for your doc. Not for your good. Your doctor's). This position does not utilize gravity as well as puts additional unnecessary pressure on the perineum.

(Side note - I did end up delivering my daughter semi reclined on my back - after trying many positions, this is where I my pushing was most effective. I did have a small tear requiring 2 stitches. I will be trying other positions again this time, however, things don't always go as planned and I know that :)

3 - Probably one of the best things you can do: When you are about to deliver baby, you, your spouse, doctor, midwife, birth attendant, whoever can use an oil (arnica is a great choice, although any nutritive oil would do) to further soften your tissues, as well as gently supporting the tissues as the head emerges by applying pressure and gently easing the skin around baby's head.

Also, perineal massage/stretching during the last few weeks of pregnancy may also help prevent tearing. One of the greatest things about this practice, besides perhaps making the tissue more 'stretchy', is practicing how to relax when feeling an uncomfortable sensation (the massage/stretching does not feel good!). The more you are able to relax down there as the baby is being born, the easier, faster and less tearing there will be. If you are able to have your partner help it works best. Breathe deeply and close your eyes. Relax your jaw. Think of happy images or places and relax. Really good practice for birth.

4 - As your baby is being born, try to really control and slow your pushing. The slower baby comes, the less amount of tearing as the tissues have a chance to stretch and accommodate. Some women will pant during this stage to keep themselves from pushing too hard. Some will give a series of short pushes instead of one big push. *Hopefully* you have a birth attendant that can coach you through this part. If the tissues are looking white - slow down (if you can!). Your birth attendant can also put gentle pressure on the babies head to prevent baby from coming out to quickly.

Ok - as I said... not a trained midwife here... so this is all I can think of at the moment. I will add more to the comments if I think of more - or if anyone else has ideas or techniques - please add them to the comments as well!

Talk to whoever is attending your birth about techniques to avoid tearing. Ask about the possibility of pushing NOT on your back. Fight for what you feel you need and want. Be your own birth advocate! (or find a good midwife! no really!) ;)

blessings in birth,

S

"Which hospital are you delivering at?"

I was asked this question at our big family Christmas dinner last night. I suppose for 99% of the population this is a totally normal and expected question.

I've been asked this several times during each pregnancy. And it still catches me off guard. I've never even considered having a baby in a hospital. It's weird because in my own private little world, in my mind, birth is normal and natural. Not a medical event. The hospital is for illness and injury - not a place to have babies! My internal thoughts go something like this...

"Hospital? I'm not sick, I'm having a baby! Childbirth is normal and there is no need for a hospital. Why would I go there? I don't like hospitals. I don't want to be in a hospital bed with people I don't know wandering in and out, with needles and tubes and beeping monitors. There are germs (bad ones like MRSA) and sick people in hospitals. Ew. I want to be in my comfy home with people that I know and love. I don't want people I hardly know poking, prodding, bathing and touching my newborn, or telling me what I need to do or can't do with him. I want to snuggle in bed with him... not put him in a car and drive him there. And.... I'm having a baby. I'm not sick."

Now, I know I'm one of a very small number that thinks this way. I'm one of a very small number that chooses homebirth because I believe it's what is best for my babies as well as myself. I know hospital births are normal and expected.

So what I say out loud is usually something along the lines of..

"Oh we homebirth with a midwife. I know... we're kind of crazy..." (Not that I believe we are crazy - but I know to a majority of the population we appear that way. It kind of diffuses the conversation at that point and most people move on... unless they are truly interested, which in that case I'm happy to talk about it :)

So thankful to have the option of homebirth.

blessings,

s

Here we go...

My first "most controversial topic" ... ok. I'm just going to put it out there. It's about circumcision.

This has been a pretty routine practice in America for ...hmmm... a little less than 100 years. (Check out the history... really interesting). It's normal, right? Well.. times are a changin'! The latest reported statistics from the CDC show that 67.5% of baby boys in America are now left intact.

Before I get into all of our reasons we have decided against circumcision, let me tell you a little about our journey.

With our first baby, husband and I talked very briefly about it. We decided that if we had a boy, we would circumcise. It was "normal" to us, and we had heard things about cleanliness and health as reasons to do it. We didn't want our son to be potentially made fun of in the locker room, etc. I also thought that if God had commanded the Jews to circumcise, there had to have been some good reason, right? We found out around 18 weeks into the pregnancy that we were having a girl, so we left it at that. We didn't do any research because it was unnecessary. Our midwife asked us if we would (with no judgement) and we said that we would but we were having a girl.. making it a non point.

Once we became pregnant the second time, I decided that I (we) should begin our research early. Really delve into the facts and find out how we really would feel given the available information. I read and read and read. I shared the important stuff with husband. And I guess what they say is true... the more you know - the more you are against it. Over a couple of months time, before we found out we were having a boy, we knew we were completely, absolutely, decidedly, definitely, unquestionably never ever ever ever ever going to do it to our child.

1. After learning that there is no medical indication for it (doesn't reduce infection, little to no effect on STD's, etc.), along with the fact that no medical organization in the entire world recommends routine infant circumcision, along with the fact that it is being done less and less in our country -- With no BENEFIT (quite the OPPOSITE) to putting my brand new, perfect little baby through pain of surgery - cutting a part off of his perfectly formed little body, I just couldn't imagine, couldn't fathom!, putting my baby through it. With all of the statistics showing no benefit, many insurance companies have deemed it what it really is (and therefore many companies no longer cover it) - an elective cosmetic surgery.
   
   
2. In addition to there being no medical benefit to circumcision, there are many risks involved, as there is with any surgery. Hemorrhage, infection and death are some immediate risks; there can also be ongoing and permanent complications. Death from circumcision may be one of the most common causes of death in babies, sadly it often goes unreported or is covered up. (Edited to add: It's estimated that as many boys die from infant circumcision as SIDS every year... SIDS is not always preventable - that we are yet aware of - but circumcision deaths are 100% preventable).
   
   Ugh... this topic is so big and I have so much to say about what I have learned, it's really overwhelming to write this....
   
   
3. The basics of the procedure: The prepuce (foreskin) of the penis is fused to the glans (head of the penis) at birth, much like your fingernail is fused to your finger. The skin eventually releases when the boy is older, 50% don't until 10 years old or later. In order to perform the circumcision, the skin must be torn apart. Forget the cutting - this has GOT to be the most painful part of the procedure (especially considering the millions of nerve endings in this sensitive part of the body!). This is something I didn't know about until researching. There are different ways of completing the circumcision once the skin has been torn apart, I won't go into that, but you can google the procedures if you like. I'm sure they are likely equally painful (although we'll never really know since our babies are too little to communicate). And remember, little to no anesthesia is used as it is too dangerous to use with a baby.
   
   
4. I have heard so many times - "do it when they are little so they won't remember the pain." Whether this is true or not (that they don't remember pain)... I just don't understand how this makes it okay?? They are brand new and have experienced little to no pain in their short lives. Some reports even say that their nervous systems are HYPER aware in the beginning. To me, the fact that they can't tell you it hurts and you can't give them any pain relievers makes the whole thing so much more awful! Poor babies...
   
   
5. "It's cleaner and / or easier to care for": Before the foreskin retracts on it's own, there is nothing different to be done. You never never never forcibly retract a foreskin. Only clean what is seen. This requires no more effort - and definitely less than a newly circumcised penis. (Check out FAQ's about care). Once the foreskin retracts, the parent shows the boy how to pull it up in the shower and let the water run over it. This is maybe different in mechanics, but little girls need to know how to clean themselves as well. And if a we are cutting little boys to be "cleaner" we should cut little girls labia off too - it would be cleaner! And they would be less prone to UTI's (girls are much more prone to infections than boys). We would never fathom cutting our little girls in the name of cleanliness. Or removing their mammary glands so they might avoid cancer in the future. Our boys deserve the same respect.
   
   
6. "We want him to look like daddy" - First of all, if daddy had a missing arm, you wouldn't cut off your baby's arm so he "looked like daddy" would you? Of course not! I have never heard of any men/boys comparing genitals with their father/sons. As women, we don't compare breasts or labia with our daughters. Yes, it is a possibility (maybe even an eventuality) that our uncircumcised boy will ask why he looks different. We will explain to him, just as we would if daddy had a missing arm (age appropriately of course). The same would go for brothers (if one were intact and the other was not). If my mom had a mastectomy, I would probably have asked about that, but never wished my breast away so I could look like her.
   
   
7. As far as biblical circumcision - it was a much different procedure than what is done today.
   
   
   "It's true circumcision was a sign of the covenant God made with Abraham, but today's procedure is not the same procedure! In Abraham's day only enough of the foreskin was removed to expose the tip of the glans (or, the 'head'). The Maccabees, during their famous revolt against the Greek domination of the Jews, changed it to the procedure known today and forced it on all Jewish men on pain of death. In the New Testament, the Apostles announced (Acts chapter fifteen) that the ordinances of the Law of Moses were no longer required."
   http://www.noharmm.org/huswife.htm
   
   
   It was a blood sacrifice. There was a little nick to the boys penis and a drop of blood was taken. That was it. Anything more and boys of that day probably would have been dying left and right from blood loss and infection. The reason why it is unnecessary for us to do this now as a Christian is the same reason we don't sacrifice lambs as burnt offerings, etc. - Jesus was the final and ultimate sacrifice. We are no longer under the law, we are under the blood of Christ.
   
   
   
   

Ok - this is getting long, so I'm just going to post some links regarding some other things and let you do the research if you feel led.

The prepuce/foreskin has a purpose! It's not just a useless piece of skin.

Christianity and Circumcision - Check out this and this and this.

Are you Informed? Short article and lots of good resources (books, websites and articles)

50 Reasons to Leave it Alone

**For mature audiences only** - entertaining and informative, but terrible language and graphic video - Penn and Teller Bullsh!t on Circumcision (Hubs and I watched this together - partially covering our eyes. Great overview on the topic if you aren't into reading).

If he chooses, my son will be able to make the decision himself someday whether he wants to remain intact or become circumcised. Until he makes that (fully informed) decision and knowingly consents to the surgery, I will not be cutting anything (unnecessarily) off of his body. It's his body and his choice, not one for me to make.

Circumcision goes against every mama bear instinct in me. I want to protect my child. To keep them whole. Unhurt. As perfect as the Lord created them to be within my womb. Some things are obviously out of my control - but circumcision is not. The prepuce has a purpose, God created it and I'll leave my son just as he was made. Whole.

Respectfully,

S

PS - I know many mom's that have made the decision to circumcise their son(s) (**I have no judgement!**) My best friend did and has since learned more about it and has decided, like many other women, that they no longer agree with it. While this must be a really difficult realization, we have to also realize that we do the best we can with the information we have. This is one reason I wanted to write this - to get information out there that is rarely if ever talked about. Whether or not you see circumcision as a "mistake" - we will all make some mistakes in parenting. None of us are perfect, nor will we ever be. We have to allow ourselves grace and room to grow and learn and become better people and better parents.

"I did then what I knew how to do. Now that I know better, I do better." - Maya Angelou

(If you click on some of the links, you will see the same blog over and over many times. This woman has a wealth of knowledge and has done years of research. She lists sources and I personally think she has provided a great resource for inquiring parents. Of course this information is available elsewhere - I just have found her very honest, readable and well cited.)

Two of Our Most Controversial Parenting Decisions

In the next several blogs (because there is no way I can fit it all into one!) I will be writing about two of what I consider to be our most controversial parenting decisions. I have been hesitating writing about either subject not just because they are controversial, but because there is a lot of hard information that I have encountered. This hard information is not always easy to take and I hate hurting or offending people. However, each subject has become very dear to me and is too important to not write about.

It's not necessarily my wish for everyone to agree with me, or to come to agree with my way of thinking. What I do wish is that people would become informed on these subjects, do their own research, and come to their own decisions and conclusions based on that research and not on hearsay, what doctor's have told you, what you grew up with, or what your family and friends do or tell you to do.

We all (well, hopefully most of us) do what we do because it's what we think is best. For ourselves. For our children. I believe when it comes to our children we have the responsibility to make each decision carefully. And with so many tools and information at our fingertips - (yes, there is a lot of misinformation on the internet, but us "thinking" individuals should be able to recognize "good" sources from "bad" and weed through the misinformation to find the good stuff!) - we have no excuse for not being informed!

Bare with me through these next few blogs. If you don't agree with me, just know that I have no judgement for those around me who live differently than I do and make different decisions than I do. I only hope to have the same respect back.

love,

s

Midwives

I wanted to write a little blog on midwives and the expertise, training and experience they have to offer.

I have heard SO many times from mama's "if I would have had a homebirth/midwife, I and/or my baby would have died!"

This statement just kills me. It is usually said by those who are just not really informed on exactly how trained and skilled midwives are. (Disclaimer: Yes, I know there are bad midwives out there - but there are also bad doctors). It is also usually said by a mama who has experienced obstetrical interventions during labor. Statistics will show that one intervention many times leads to another. Whereas if you leave birth alone, it is much less "dangerous" and usually requires no (or very little) intervention.

Midwives, specifically homebirth midwives, lay midwives, direct entry midwives, etc. really only work with women with normal, low-risk pregnancies (the same can be said about CNM's, but as they usually work in hospitals there is more leeway there).

An OB will use medical "tools" to diagnose a high-risk pregnancy (ultrasound, namely). Midwives use their own tools to come to the same (sometimes even more accurate!) conclusion.

Measuring fundal height is one tool used by midwives for checking on babies growth as well as fluid levels.

Palpating the uterus will tell midwives many things, such as the babies position (checking for breech).

Midwives use dopplers and fetoscopes to listen to the heartbeat as well as placental sounds.

Midwives routinely check pH, protein, etc in mama's urine. They also run blood tests multiple times throughout pregnancy, as well as check pulse and blood pressure at every visit.

These are just a few of the "tools" that midwives use to monitor the health of mamas and babies. If at any time they are unsure of something, if mama is showing signs that something isn't quite right, they will immediately refer her to an OB. If everything checks up as normal, they can continue care with the midwife. However, if there is something not right, they would transfer care to the OB.

Many/most midwives have EXCELLENT records for outcomes as far as maternal mortality, fetal mortality, as well as transfer to hospitals, c-section etc. They do not take risks - the mama and baby's health are of the utmost importance to the midwife. They know and understand their abilities as well as their limitations (such as - they cannot perform a c-section).

This is true for the prenatal period as well as during labor and birth. Midwives are highly skilled and trained to recognize all complications of labor and birth. And again, they don't take risks, they will transfer to hospitals at the earliest signs, not waiting for things to get too far.

Midwives usually carry oxygen as well as some drugs (such as pitocin) to their births. I had oxygen during my labor toward the end when I was running out of energy. I also had some excessive bleeding after the birth. My midwife gave me a shot of pitocin in the leg to help my uterus to clamp down quicker, slowing the bleeding down quickly.

They are also trained in infant resuscitation and carry tools for that as well.

Midwives are highly trained in normal pregnancy and birth. More so than OB's, who are trained in pathology and surgery.

Homebirth is not for everyone, and not even everyone who wants one can have one (if they "risk out"). However, for those women who have normal pregnancies it is just as safe - if not SAFER than a hospital birth. (Statistics support this statement, unfortunately those who oppose homebirth report statistics that include unintentional homebirths, including those on the way to the hospital, etc. that are not attended by a skilled midwife).

My midwife has delivered over 1,000 babies and has an excellent record of success in all realms. She is truly an expert on birth!

love,

s

Pregnant or hope to be someday?

If you are pregnant now or hope to be someday, no matter what kind of birth you want or plan to have, I really strongly recommend picking up a copy and reading Ina May's Guide to Childbirth. Even after doing tons of research with my first, and actually experiencing childbirth, I'm still learning SO MUCH! It is really wonderfully written, easy to read and engaging.

I think it's so important for every woman to read this book. I found it at my library.

Midwife and author Ina May Gaskin is truly an expert in pregnancy and childbirth. The insight she has to offer is so invaluable. If you only read one book during your pregnancy, choose this one!

Birth and the Two Models of Care

Whether you choose an OB or a midwife to provide your pregnancy, birth and postpartum care, there is something that will influence the outcome of your experience more than anything. This is whether your provider practices under the medical model of care or the midwifery model of care.

It seems like it would be pretty cut and dry - OB's practice the medical and Midwives practice the midwifery. Right?

While the vast majority of the time this might be true, there are still plenty of exceptions.

The two models of care by definition:

The Midwives Model of Care

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

• Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
• Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
• Minimizing technological interventions
• Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights Reserved.

http://cfmidwifery.org/mmoc/define.aspx

I couldn't find a definition of the medical model of care, but I found this table making some comparisons of the two models:

Midwives Model of Care Medical Model of Care Definition: Definition: • Birth is a social event, a normal part of a woman's life. • Birth is the work of the woman and her family. • The woman is a person experiencing a life-transforming event. • Childbirth is a potentially pathological process. • Birth is the work of doctors, nurses, midwives and other experts. • The woman is a patient. Definition: Definition: • Home or other familiar surroundings. • Informal system of care. • Hospital, unfamiliar territory to the woman • Bueaucratic, hierarchical system of care Definition: Definition: • See birth as a holistic process • Shared decision-making between caregivers and birthing woman • No class distinction between birthing women and caregivers • Equal relationship • Information shared with an attitude of personal caring. • Longer, more in-depth prenatal visits • Often strong emotional support • Familiar language and imagery used • Awareness of spiritual significance of birth • Believes in integrity of birth, uses technology if appropriate and proven • Trained to focus on the medical aspects of birth • "Professional" care that is authoritarian • Often a class distinction between obstetrician and patients • Dominant-subordinate relationship • Information about health, disease and degree of risk not shared with the patient adequately. • Brief, depersonalized care • Little emotional support • Use of medical language • Spiritual aspects of birth are ignored or treated as embarrassing • Values technology, often without proof that it improves birth outcome

http://www.morningstarbirth.com/index.cfm?event=pageview&contentPieceID=3225

M(idwives in) D(isguise)

Some OB's, even while working in the hospital, do work under the assumptions of the midwifery model of care. One indicator would be their percentages of interventions (induction, c-section, vacuum, forceps, episiotomies, etc). Low percentages of interventions would indicate they may work under the midwifery philosophy, using interventions only when REALLY necessary.

MEDwives

In contrast, some midwives who work in hospitals work under the medical model of care. They usually work closely with an OB. Their purpose is more as an attraction to women who want a midwife but still opt for a hospital birth. The care is similar to that of an OB.

The "title" your caregiver possesses does not necessarily dictate the kind of care you will get or the kind of birth you will have. It is important to find a caregiver whose birth philosophy matches your own if at all possible. Yes, we all want healthy babies in the end. But our experiences in childbirth, our hopes and desires, matter as well.

-S